Aneurysmal degeneration and rupture of deep vein conduit with formation of an arterial-vaginal fistula 13 years after creation of a femoral-femoral bypass

The autologous deep vein is a suitable alternative to prosthetic or cadaveric grafts as a bypass conduit because of its superior durability and lower risk of complications. Aneurysmal degeneration of deep vein grafts is rarely seen but can potentially be fatal when it does occur. We describe the case of an 87-year-old woman who presented with acute vaginal bleeding due to the rupture of an aneurysmal femorofemoral bypass vein graft into the vagina. The patient presented 13 years after the initial procedure, highlighting the need for long-term monitoring and the early recognition of this potentially catastrophic complication.